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Fed up with forms

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The forms are more than time consuming, they consume our spirit and our free thinking.

We are losing our pride and our joy in being doctors. Filling forms prevents us from being ever satisfied in mastering our clinical skills. Such clinical skills are an art which need high knowledge, experience, understanding and a free empathic spirit able to reflect openly, communicate clearly and make decisions about whatever clinical situation arises. Mastering theses skills needs time and an open mind. Filling forms simply anesthetises us and I believe can prevent us in acquiring this capability.

As mentioned by Margaret, feedback forms, 360 degree appraisals, team assessment of behaviour, audits, policies are all used by the appraisal process and CQC to make a judgement on us. But note, all these forms follow a deterministic model, which can only lead to oversimplification and not to a true picture. It is certain that the judgement made with these forms will not improve our care for our patients, and in my opinion will be often wrong. Time will tell! However, ditching the forms now will help all of us to protect our medical skills, to keep sane and to keep supporting each other.

The appraisal process and CQC policies force any individual to introspection, not giving much opportunity for team work. In filling in these forms, we see ourselves as one isolated individual and we can forget to feel part of a team. The team dynamic per se is not analysed with these forms, the team is just reduced to a group of people who can criticise but not support each other. In these forms, it is about one individual doctor judged by his patients and colleagues. The appraisal and revalidation concepts are isolating all of us and in doing so will promote anxiety and other psychological and psychiatric conditions, which are already too frequent in our profession.

We often hear that we should not be concerned about this if we are good doctors. This plain and simplistic argument is in some way scary. We should all know our history and that this very argument has been used before in other contexts.

So, should we ditch these forms, yes we should!

"We are meant to be workers with vocation, who think, reflect, critic and support each other" .

Margaret McCartney's words are reassuring me that there are individuals who still believe in the idea of vocation, who believe that free thinking is necessary to doctors, that we are all skilled enough and well equipped to reflect and support each other without the need of big brother watching over us. So yes, ditch the forms!

The puzzle is why on earth an intelligent and caring profession has allowed all this to happen. I have just retired as a GP and an Appraiser and all around arè disgruntled doctors. But the irony is that it is not politicians or managers that are at fault. It is our own colleagues who have introduced and forced upon us this paper chase. Why don't we just say No?

During my limited experience as a junior doctor, I have often found myself asking the exact same question Dr. McCartney asks; "where's the joy in medicine?". I was once informed that it could possibly be found somewhere in amongst the virtual piles of online bureaucracy. Maybe it lay beneath that fourth 360˚ appraisal or possibly between the sixth mini-cex and twelfth reflective practice entry? I spent month after month searching, yet to no avail.

Until recently that is. Now, as a junior doctor currently "out-of-training" on the other side of the world in New Zealand, I am reveling in the joy of medicine. Because now I have the opportunity to learn for learning's sake, rather than learn purely to prove to the powers that be, that I am indeed learning.

I no longer waste precious time chasing people to fill out online assessments, which invariably deem me to be simply "average", because to write that I am above average would require my assessor to complete even more boxes with a justification for their assessment. Conversely, to be simply "average" requires no further justification. I no longer spend evenings working half-heartedly on my e-portfolio, whilst the TV lingers on in the background.

Now I am free to read up on my patients' conditions, simply because I wish to update my knowledge, liberated from any ulterior motive. On quiet days on the ward, I am able to observe endoscopy or help assess patients in clinic. I often follow the echo technician to learn ultrasound skills. I am free to badger the radiologists with burning questions about scans I cannot fully interpret alone.

Yet when I return to the UK for further training, I will be forced to forgo a wide range of learning opportunities to ensure that I complete the desired numbers of tick-box competencies (which by no means would deem me competent in any such skill). I will continue to chase down my assessors to fill out yet another online form and collect the required number of certificates to prove that I am indeed training the way the leadership expects me to train. I can only hope that there will be times, in between the monotony of the tick-box exercises that will form the basis of my training, to re-discover moments of joy that will remind me of exactly why I chose a career in medicine.

I totally agree that we need to listen to our patients and to each other - i.e. other doctors - to experience the joy in medicine.

Don't you think that we also need to listen to other professionals interested in health and well being and follow the wise words of Theodore Zeldin in How work can be made less frustrating and conversation less boring with the editorial by Clever on the frustrations of relationships www.bmj.com/content/319/7225/1633

I believe that in the past 30 years our lack of interest and our inability as GPs to share conversation and ideas with librarians, play workers, community development workers, poets and artists has led to our "silo" mentality.

To a certain extent we only have ourselves to blame for the sad state that you have so clearly identified.

I was recently asked to “write” a reference for two of my trainees who were applying for ST3 posts in cardiology. I thought this might be time consuming but in the end the form simply required me to tick two boxes confirming that I would be happy to work with them again and that I was able to recommend them for the post they had applied for. There was, just under this, the smallest box for any additional comments discouraging any creative prose.
One upon a time the ability to get on in medicine was very strongly dependent on the reference one got from your consultant. It was believed that references made or broke success in a job application. In a sense this perhaps bred a spirit of nepotism but in my experience it was common for people to work hard to impress their boss with the thought that a good reference would follow and this would open the door to future career success.
As human beings we need drivers and incentives work hard. Medicine has always attracted driven and ambitious individual but this was supplemented in times past by a desire to work hard for the firm, because nobody wanted to let anyone else down, and to impress the boss.
Now the medical world is reduced to tick boxes on forms the reference is merely a minor clerical check in the process of recruitment after the decision has been made to award the post to the applicant. My feeling is that these type of references should be provided by a functionary in the human resources department and not by consultants.